Healthcare Provider Details

I. General information

NPI: 1104845148
Provider Name (Legal Business Name): MATHIEU LANE HINZE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 LUCILE DR STE 103
LINCOLN NE
68516-4211
US

IV. Provider business mailing address

4400 LUCILE DR STE 103
LINCOLN NE
68516-4211
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-2572
  • Fax: 402-483-2619
Mailing address:
  • Phone: 402-483-2572
  • Fax: 402-483-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number15894
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: